Healthcare Provider Details

I. General information

NPI: 1053880021
Provider Name (Legal Business Name): ANGELO'S CARE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 UNION CHAPEL RD
PEMBROKE NC
28372-8689
US

IV. Provider business mailing address

10091 US HIGHWAY 74 W
MAXTON NC
28364-8936
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-1895
  • Fax: 910-521-7220
Mailing address:
  • Phone: 910-521-1895
  • Fax: 910-521-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDY LOCKLEAR
Title or Position: DIRECTOR
Credential:
Phone: 910-521-1895